Impact of "non-clamping technique" on intra- and postoperative course after laparoscopic partial nephrectomy

Introduction: The use of kidney warm ischaemia during laparoscopic partial nephrectomy (LPN) may lead to damage of renal vessels and kidney failure. Laparoscopic partial nephrectomy done without clamping the renal pedicle is feasible and may be beneficial for the postoperative course. Aim: To compare intra- and postoperative course in patients undergoing LPN with and without kidney warm ischaemia. Material and methods: The material comprises 38 consecutive patients, who underwent LPN in our department during the years 2008-2009. In all cases renal vessels were identified and dissected at first, then resection of the tumour was done. Warm ischaemia was used only in case of difficulties with identification of tumour margin or with the management of bleeding. Out of 38 operations 13 were done without clamping the renal pedicle (group 1) and in the remaining 25 warm ischaemia was applied (group 2). Results: Mean dimension of resected tumours in groups 1 and 2 was 31 mm and 33 mm respectively (p > 0.05), while parameters of intra- and postoperative course differed significantly between the groups: mean blood loss -135 ml vs. 354 ml (p < 0.05), time of surgery -72.6 min vs. 132.2 min (p < 0.05), postoperative drain leakage -290 ml vs. 504 ml (p < 0.05), postoperative hospital stay -3.1 days vs 5.3 days (p < 0.05). In all patients baseline creatinine levels were normal while after surgery creatinine elevation over the upper limit was found in groups 1 and 2 in one and in 6 patients respectively (p < 0.05). Conclusions: Laparoscopic resection of kidney tumour without warm ischaemia is feasible and beneficial in pre- and intraoperatively selected cases. Bleeding from renal parenchyma, which requires renal pedicle clamping, may seriously deteriorate intra- and postoperative course in patients undergoing laparoscopic partial nephrectomy.